Household dining yields lower costs, higher satisfaction

A household dining model using satellite kitchens results in lower net costs for communities and an improved dining experience for residents, according to Mitchell Elliott, AIA, an architect and chief development officer of Vetter Health Services.
The Omaha, Neb.-based privately held owner and operator of 30 long-term care communities—primarily skilled nursing—in the Midwest has been experimenting with dining options since 1998, Elliott said. Those options have included traditional dining; household dining with serving kitchens, with most food prepared in a central location and delivered to serving lines; and household dining with satellite kitchens, with more food being prepared closer to the living spaces. May 5 at an Environments for Aging Conference session titled "Household Dining: A Bad Aftertaste or a Succulent Delight?" Elliott and Ed Rowswell, culinary coordinator, and Mary Ann Thurman, MAM, RDN, LMNT, CDP, dietary services coordinator, shared the company's experiences.
Satellite dining facilitates resident choice by enabling items to be prepared to order, Thurman said. Also, because food is prepared closer to where it is eaten, it is more nutritious, more attractive and served at a more ideal temperature, resulting in increased consumption and a reduction in weight loss among residents, she added.
When planning dining rooms that have satellite kitchens, Vetter makes them big enough to accommodate 20 percent more people than resident capacity, Elliott said; because the food is better, more resident family members dine in the communities.
When it comes to staffing under the model, Thurman said, "We consider eating an ADL. It's 'all hands on deck.' " Nurses are "very engaged" in the process, working with dietary staff members to see that all residents are served, she added.
Some employees won't like the changes—for instance, a dietary staffer may not welcome participation by nursing staff, or nursing staff may not wish to participate in serving meals. That's why it's important not to measure the success of a household dining model based on staff turnover, Elliott said. "You're going to lose people. Some people just can't make the transition" from a traditional dining model, he added. 
Vetter researched its food costs and surveyed residents and their families and found that the increase in food costs associated with a satellite kitchen was "more than offset" by a decrease in staffing costs—and quality improved, Elliott said.
Specifically, Vetter found that offering household dining with a satellite kitchen resulted in a 16 percent increase in food costs compared with using a central kitchen. Rowswell attributed the cost increase to increased inventory to enable resident choice as well as the higher number of family members eating at the communities.
Dietary staffing costs under the satellite kitchen model, however, were 72 cents per patient day (ppd; meaning that if a resident's charges were $100 per day, 72 cents of that amount goes toward staffing) compared with 80 ppd under a central kitchen model. "Multiply that by 365 days per year by 120 residents and you start to see some benefits," Elliott said.
Benefits are more than financial, he added. Vetter surveyed residents of one community and their family members and found that 80 percent and 45 percent, respectively, "strongly agreed" that the community offers a quality dining experience under the household dining model, compared with national averages of views of overall dining experiences of 31 percent and 30 percent, respectively. When asked about the quality of meals, 100 percent of residents and 52 percent of their family members said that the quality of meals was "extraordinary" under the household model, compared with national averages of the views of overall meal quality of 29 percent and 33 percent, respectively.
"Everyone has an opinion about food, and we are serving a generation of good cooks," so the results are encouraging, Elliott said.

Design considerations

When moving to a household dining model, Elliott said, several design considerations are important to ensure that the spaces not only are beautiful but also are functional. Among them:
  • the distance between where the food is prepared and where it is served (which has efficiency, visual, nutritional, food safety and housekeeping ramifications);
  • ergonomics for staff members (for instance, use of an under-the-counter dishwasher may result in back problems);
  • safety issues, including all applicable laws, regulations and codes;
  • the size and layout of the kitchen and dining areas to enable efficient and resident-friendly serving as well as socialization;
  • location of commercial equipment in a way that maintains a home-like atmosphere while accommodating the needs of staff members; and
  • placement of areas for ice so that everyone needing to access it has it.
Collaboration is vital so that all considerations are included in the design process, he said.
The household dining room with satellite kitchen in Vetter Health Services’ Brookstone Meadows community offers residents an improved dining experience. (Photo by Tom Kessler)
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